Provider Demographics
NPI:1124229125
Name:FREEDOM HOSPICE
Entity Type:Organization
Organization Name:FREEDOM HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRILL
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:DEJACIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-493-4930
Mailing Address - Street 1:6666 S SHERIDAN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1756
Mailing Address - Country:US
Mailing Address - Phone:918-493-4930
Mailing Address - Fax:918-346-6400
Practice Address - Street 1:6666 S SHERIDAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1756
Practice Address - Country:US
Practice Address - Phone:918-493-4930
Practice Address - Fax:918-346-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK371657251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371657OtherPROVIDER NUMBER